1568870772 NPI number — NORTH HOUSTON MC, LLC

Table of content: (NPI 1568870772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568870772 NPI number — NORTH HOUSTON MC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH HOUSTON MC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PATHWAYS MEMORY CARE AT VILLLA TOSCANA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568870772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 WATERS RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-6011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-899-4401
Provider Business Mailing Address Fax Number:
972-899-4806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2930 CYPRESS GROVE MEADOWS DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77014-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-315-1450
Provider Business Practice Location Address Fax Number:
281-315-1475
Provider Enumeration Date:
07/31/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
AUTHORIZED OFFICER
Authorized Official Telephone Number:
972-899-4401

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)